Fillable 2017 SERO Homestay Application Form 21 (Australian National University)

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2017 SERO Homestay Application Form 21 (Australian National University)

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The 2017 SERO Homestay Application Form 21 (Australian National University) form is 2 pages long and contains:

  • 1 signature
  • 32 check-boxes
  • 39 other fields

Country of origin: AUSTRALIA
File type: PDF

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HOMESTAY APPLICATION
STUDENT DETAILS Student ID: ____________________________________
Family Name: ______________________________________ Given Name: ________________________________________
Nationality: ________________________________________ Date Of Birth: ___________________ Male Female
Address: _______________________________________________________________________________________________
Telephone: ________________________________________ Email: ______________________________________________
Native Language: _____________________ English Level: _______________________ Religion: _______________________
Homestay Start date: ________________________________ Homestay Finish date: _________________________________
Course Name: _______________________________________________________________ Start date: __________________
Do you enjoy the company of children? Yes No Do you smoke? (outside only allowed) Yes No
Will you accept pets (inside/outside)? Yes No Have you ever lived in another country? Yes No
Any allergies or special needs? Yes No Please give details ___________________________________
Do you take regular medication? Yes No Please give details ___________________________________
Any special diet e.g. halal/gluten free? Yes No Please give details ___________________________________
Do you require Internet? (charges apply) Yes No You must provide your own laptop, tablet/iPad or smart phone
What are you hobbies/special interests? _____________________________________________________________________
AGENT DETAILS
Company: _________________________________________ Contact Name: ______________________________________
Address: _______________________________________________________________________________________________
Telephone: ________________________________________ Email: ______________________________________________
PLACE OF STUDY
School/College: ______________________________________________________________________________________
Email: _____________________________________ Start date: _________________ Finish date: _________________
Will you be studying at another institution after this one? Yes No Where: _________________________________
ACCOMMODATION CATEGORY (Please tick)
Package 1
Package 2
Package 3
Package 4
Transport
Room Only
(no meals)
Breakfast &
dinner daily
2 meals Mon-Fri
3 meals Sat-Sun
3 meals per day
Travel to and
from school only
AIRPORT TRANSFER
Arrival Only Return Private transfer Basic transfer
(Met at Customs gate) (Go to Con-x-ion desk)
Arrival Airport: ______________________________________ Arrival Date: ____________________________________
Flight Number & Airline: _______________________________ Arrival Time: ____________________________________
Departure Airport: ___________________________________ Departure Date: _________________________________
Flight Number & Airline: _______________________________ Departure Time: _________________________________
PAYMENT METHODS AVAILABLE
Bank Transfer or Telegraphic Transfer (*Telegraphic Transfers incur a $20 fee)
National Bank, Brisbane Account Name: GCSAC
NAB Swift Code: NATAAU3303M BSB: 084-510 Account: 161995432
Credit Card payments are available (a 3% surcharge applies).
Please provide your account name, card number, expiry date and CCV number (form available upon request)
HOMESTAY CONTRACT
I, ……………………………………………………………………………………….. (your name) will advise Australian Student Accommodation
immediately if I change any arrival or contact details, no longer require accommodation or cancel my enrolment at my place
of study. I agree to abide by the Homestay rules and act maturely and responsibly at all times while living with a Homestay
family. I understand that breaking Australian law, verbal or physical aggression, repeated intoxication or inappropriate
behaviour towards the Homestay family will be seen as a breach of contract and I will be asked to find alternative
accommodation immediately at my own expense, with no refund of monies already paid.
Signature:………………………………………………………………...……………………………………………… Date:…………………………………..…………
TERMS & CONDITIONS
Unless prior agreement has been made with an education provider, students are required to pay the provider before arrival
in Australia for the first four weeks of accommodation – this is not refundable. If the student is studying for less than 4 weeks
the length of stay will be equivalent to the length of course or as organised by the tour coordinator or education provider.
Australian Student Accommodation must be notified of the length of stay.
*Note: All prices are subject to change and may vary if application is placed through another organisation.
PRICE LIST
HOMESTAY WEEKLY RATES (over 18 years single)
PACKAGE 1
Room Only
(no meals,
self-cater)
PACKAGE 2
Breakfast &
Dinner per day
PACKAGE 3
Breakfast & Dinner
weekdays, all meals
weekends
PACKAGE 4
3 meals
per day
TRANSPORT
Brisbane $50
Gold Coast $30
INTERNET
Average 2GB
per week
SPECIAL DIETS
Halal, Coeliac,
Gluten Free,
Diabetes
$175
$245
$255
$275
From $30
$10
$50
Different prices apply for twin share, groups or Study Tours and students under 18 years of age.
Special dietary needs such as halal or gluten free meals incur an extra fee of $50 per week
AIRPORT PICKUP
Private transfer from Brisbane Airport to Gold Coast accommodation
$125 per person
Private transfer from Brisbane Airport to Brisbane accommodation
$100 per person
Private transfer from Gold Coast Airport to Gold Coast accommodation
$100 per person
EXTRAS – Unaccompanied Minor Service / Surfboard Collection / Late Arrival between 10pm-5am
$40 per person
Basic shuttle bus transfer from Brisbane Airport to Gold Coast accommodation
$80 per person
Basic shuttle bus transfer from Gold Coast Airport to Gold Coast accommodation
$50 per person
PLACEMENT FEE
Placement fee is $220 (incl. GST) per student payable to Australian Student Accommodation
upon submission of the Application form.
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2017 SERO Homestay Application Form 21 (Australian National University)

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Completed 28 July 2021

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